Clinical Focus: Findings and Clinical Implications for Thickening Formula With Infant Cereal Using the International Dysphagia Diet Standardisation Initiative Flow Test.

PURPOSE: The International Dysphagia Diet Standardisation Initiative (IDDSI) framework was established to provide standardized terminology and objective measures to assess foods and liquids for persons with swallowing difficulties. This clinical focus article reports the findings and clinical implications of the flow testing of infant formulas thickened with infant cereal completed as part of the transition process to IDDSI for one large pediatric quaternary care hospital. METHOD: To determine a common recipe that could be used to thicken formulas with infant cereal to the appropriate IDDSI levels, three clinicians completed flow testing on 94 infant formulas. To examine intra- and interclinician variability in the process, they repeated flow testing with three commonly used formulas and infant cereal. RESULTS: Clinicians were unable to identify a standard recipe (infant formula + infant cereal combination) that consistently thickened different formula brands to a desired IDDSI thickness level, as there was pronounced variability across and within infant formulas. Reliability testing revealed that, overall, clinician mixers were consistent in replicating similar results to themselves and to each other and that, instead, greater variability lies within the formula (and infant formula + infant cereal combination). CONCLUSIONS: Based on findings of pronounced variability within and across infant formulas, our institution determined that the creation of a standard recipe for achieving IDDSI thickness levels of formula mixed with infant cereal was not feasible or clinically appropriate. We offer recommendations for similar institutions for advancing clinical management of infant dysphagia using the IDDSI flow test and directions for future research.

Standards of Practice for Occupational Therapy.

This document defines minimum standards for the practice of occupational therapy. According to the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF-4), occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations (i.e., the client) for the purpose of enhancing or enabling participation. . . . Occupational therapy services are provided for habilitation, rehabilitation, and promotion of health and wellness for clients with disability- and non-disability-related needs. These services include acquisition and preservation of occupational identity for clients who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. (American Occupational Therapy Association [AOTA], 2020c, p. 1).

Improving Occupational Performance in Pediatric Hematopoietic Cell Transplant Recipients.

IMPORTANCE: There is a critical gap in the literature regarding the efficacy of occupational therapy interventions for pediatric hematopoietic cell transplantation (HCT) patients. OBJECTIVE: To demonstrate that occupational therapy 4-5×/wk during inpatient hospitalization positively affects strength, coordination, and independence in activities of daily living (ADLs) of pediatric patients during HCT. DESIGN: Retrospective study. SETTING: Inpatient bone marrow transplant unit at a children's hospital. PARTICIPANTS: Thirty-two pediatric patients admitted for HCT. OUTCOMES AND MEASURES: Patients were seen by an occupational therapist as part of an interdisciplinary program. Interventions included play and leisure engagement, upper extremity therapeutic exercises, fine motor activities, and ADL training. Strength, coordination, and daily living skills data were documented prospectively and analyzed retrospectively to compare differences between patients seen by occupational therapy at high versus low frequency. RESULTS: For grip strength (dynamometer), fine motor dexterity (the 9-Hole Peg Test), and independence in ADLs (an ADL functional measure and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test Daily Activities), the high-frequency group had a significantly smaller decrease in performance from time of admission at pretransplant (baseline) to peak decline after transplant. Grip strength and ADL scores for the high-frequency group returned to baseline at time of discharge more readily than for the low-frequency group. CONCLUSIONS AND RELEVANCE: Participation in occupational therapy 4-5×/wk had positive effects on strength, coordination, and independence in ADLs for patients undergoing HCT. WHAT THIS ARTICLE ADDS: This article provides evidence that occupational therapists are an important part of the interdisciplinary team treating pediatric bone marrow transplant patients. It also demonstrates that occupational therapy interventions delivered at a high frequency can have a positive impact on upper extremity strength and independence in ADLs.